This blog is aimed at introducing a number of examples of national strategies that have been launched to improve safety in healthcare for children. The WHO informs that although childrens’ health has improved dramatically over the last 20 years with a reduction in mortality; globally the number of children dying before the age of 5 has halved between 2000-2017. However further work is needed to improve access to healthcare and provide children with appropriate environments to thrive. The NHS in the UK was founded to improve childrens’ lives, with healthy children becoming healthy and economically more productive adults. However, in 1945 there were more people under the age of 16 years, whereas now there are more over the age of 65. We are now expecting the NHS to work for an ageing society with no limit on the ever growing demand. To counterbalance we must renew our focus on the young with prevention in the development of disease as mandated by the new NHS 10 Year Plan in England. The aim is to change the focus from sickness to prevention with a goal to ‘to raise the healthiest generation of children ever’. While prevention for children is not entirely aimed at safety it runs in parallel with improving health and avoiding harm to our next generation, and is therefore included in this blog. 

 What's different for babies and children

Safety in children is fundamentally different to adults as outlined by Woods et al., due to their changing physiology as they develop affecting vital signs, drug dose, communication, and equipment. Other factors affecting children more specifically can be their dependency, different diseases at different ages, and the impact of social determinants.  In 2007 the Confidential Enquiry into Maternal and Child Health (CEMACH) report ‘Why children die’ found there were preventable factors in 26% of reviewed cases; most were related to poor communication and delayed recognition of the deteriorating child.  

Maternity and neonatal safety improvement programmes

One improvement programme, the Maternity and Neonatal Safety Improvement Programme by NHS England was renamed following the launch of the NHS Patient Safety Strategy in 2019, updated February 2021. The Programme is led by the National Patient Safety Improvement Programme team and covers all maternity and neonatal services across England. It has been supported by 15 regionally based Patient Safety Collaboratives of the Health Innovation Network, although sadly this can now no longer be relied on. It aims to: 

The Maternity Transformation Programme (MTP) also aims to allow for national digital records aimed at maternity and neonates to improve safety for these groups. 

Reducing health inequalities in children

Another example of an initiative to improve healthcare and reduce inequalities in children is the national NHSE Core20PLUS5  aimed at a national and system level for children in 2022. This focussed on the 20% most deprived childrens’ groups using the Index of Minority Deprivation on 5 key areas of health inequality. These are: 

Asthma – reduce reliance on medication and number of attacks. 

Diabetes – increase continuous glucose monitors and insulin pumps. 

Oral Health – address the backlog for admitted inpatients for tooth extractions under 10 years of age. 

Mental Health – improve access to services for children and young people. 

Epilepsy – improve access to epilepsy specialist nurses for those with LD or autism. 

Deterioration

The importance of early recognition of deterioration of mothers, neonates and children gained momentum in 2018 following collaboration between NHS England and the Royal College of Paediatrics and Child Health (RCPCH) and the Royal College of Nursing (RCN). Nationally developed tools and scoring systems have been developed  to give consistency in how deterioration in mothers, neonates and children is recognised in secondary care settings to improve the prevention, identification, escalation in deterioration through: 

Newborn screening programmes 

Examples of those offered by NHS England include: 

The parents of new babies at 5 days old in England are offered blood spot tests to screen for 9 life debilitating conditions allowing treatment and or monitoring in a timely manner: 

With 1 to 2 babies in every 1000 born with permanent hearing loss within the first few weeks/months of birth new babies are offered a hearing test. Identification of hearing loss can give the babies a better chance of developing language, speech and communication skills to allow them to develop relationships from an early age. 

Offered before 3 days and at 6-8weeks old to allow for early treatment this includes: 

 Vocational programmes 

While there is significant global variation in vaccination programmes, these are constantly changing with the development of new vaccines. With the eradication of Smallpox through vaccination in 1980, the WHO is aiming to eradicate Polio globally by 2026.  

Currently in England vaccinations are aimed at the under one year olds with the 6-in-1 vaccine protecting babies against 6 serious illnesses: Diphtheria, Hepatitis B, Hib (Haemophilus influenzae type b), Polio, Tetanus, and Whooping Cough. Other vaccines given to the under ones in England include Rotavirus, Meningitis B, and Pneumococcal vaccines. From the ages of one to fifteen years vaccinations include boosters for some of the previous mentioned, and Measles, Months, and Rubella (MMR), Meningitis C, and Human Papilloma Virus (HPV).  

The HPV vaccination included boys from 2019 following a national campaign to reduce the risk it affords against oral cancer. Worryingly the uptake for childhood vaccinations has seen recent decline which may in part be fuelled by a reduction in trust of vaccines, resulting in a spike in the development of diseases such as Measles and increased risk to childrens’ safety over recent years.  

Safeguard 

The concept of safeguarding newborns and children has become more embedded across organisations in contact with children, including the NHS over the last few years. All children are considered ‘vulnerable’ and subject to safeguarding legislation. Safeguarding governance structures are clearly defined in NHS England’s safeguarding accountability and assurance framework (SAAF 2024). Healthcare organisations must have appointed leaders to deliver on safeguarding for children, who also have a duty to ensure their staff are trained to appropriate levels to recognise and act proportionately where a  safeguarding issue relating to any child is suspected. Organisations also have a responsibility to share information when required to identify children at risk of harm. 

MARTHA’S RULE 

In 2024 NHS England piloted Martha’s Rule at 149 pilot sites, this has now been rolled out in most NHS Trusts. This was introduced following the sad and avoidable death of Marth Mills at the age of 13 years from sepsis, which was not escalated in time to save her life despite her parents raising concerns. There are 3 components empowering patients, carers and staff to raise concerns about potential deterioration of patients: 

Learning from patient safety events in children

The Patient Safety Incident Response Framework (PSIRF) has set national priorities relating to patient safety events that occur in mothers, neonates and children that should be prioritised in terms of a response as follows: 

EDUCATION AND TRAINING OF STAFF 

In addition to the statutory and mandatory requirements for safeguarding training for NHS staff, in line with the National Patient Safety Strategy 2019, maternity leads have been appointed and trained Patient Safety Specialists in healthcare organisations across England. As an add on to the Level 2 National Patient Safety Syllabus E-Learning for healthcare, there is now a specific module available for NHS staff to improve their understanding of safety in maternity which in turn improves safety for our newborns.  

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